Imaging in Precision Medicine for Diabetes

In humans with diabetes, differences in tissue-specific metabolism and diabetes-related comorbidities and complications are present already at diagnosis. Recent advances in comprehensive phenotyping may allow for improved targeted prevention and treatment in the near future. Noninvasive in vivo imaging tools have become essential for comprehensive phenotyping in metabolic diseases. This chapter focusses on (i) methods for assessing body composition and tissue compartments, specifically adipose, skeletal muscle, liver, pancreas, and heart, (ii) functional analyses including spectroscopic techniques for in vivo metabolic flux analysis (fluxomics), and (iii) assessment of some comorbidities and complications, such as cardiovascular, hepatic, and retinal abnormalities. Combined with other tools, e.g., multi-omics, these developments have already yielded novel insights into the pathogenesis of diabetes, but now also allow for further sub-phenotyping of people with diabetes and thereby contribute significantly to the concept of precision diabetology for stratified prevention and therapy of diabetes and its complications.